Provider Demographics
NPI:1528043007
Name:CLARKE, CATHERINE JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JANE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1325 EASTMORELAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3519
Mailing Address - Country:US
Mailing Address - Phone:901-516-8785
Mailing Address - Fax:901-516-2119
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-516-8785
Practice Address - Fax:901-516-2119
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3838192Medicare ID - Type Unspecified
G88635Medicare UPIN